Recurrent Fever Episodes with Arthralgia or Hyperesthesia – Have You Ruled Out Parvovirus B19?

Introduction

The spectrum of clinical symptoms of parvovirus B19 infection is broad and includes transient aplastic anemia, classical erythema infectiosum, fever, arthralgia as well as a variety of other symptoms. Monosymptomatic parvovirus B19 infection presenting with recurrent fever only appears to be an unusual manifestation. In the immunocompromised host ineffective elimination of the virus can lead to chronic anemia. Even in immunocompetent patients parvovirus B19 DNA can asymptomatically persist in bone marrow, myocardium, liver, synovial tissue and skin for a prolonged period of time (for reviews see Heegaard ED et al., Clin Microbiol Rev 2002; 15: 485–505; Lehmann HW et al., Monatsschr Kinderheilkd 2004; 152: 203–214).

Arthralgia and arthritis are typical clinical manifestations in adults, but less so in childhood. Usually, parvovirus B19 associated arthritis subsides within few weeks, a persistence of this symptom is rarely observed (Vassilopoulos D et al., Arthritis Res Ther 2008; 10: 215).

We report on 2 caucasian boys with recurrent fever for several months, who, following extensive diagnostic workup without conclusive results, were admitted to our hospital for exclusion of malignant disease. Whereas no evidence of malignancy was present, virologic tests revealed persistent parvovirus B19 infection.